UPMC Physician Resources

Welcoming New Faculty to Children’s Hospital of Pittsburgh of UPMC

Children’s Hospital of Pittsburgh of UPMC is pleased to welcome three new faculty members.

Marcus Malek, MD, has joined the Division of Pediatric General and Thoracic Surgery as the director of pediatric surgical oncology. He has completed dual-fellowships in pediatric surgery (at Children’s Hospital of Pittsburgh) and pediatric surgical oncology at the Memorial Sloan-Kettering Cancer Center in New York City. Dr. Malek is one of the few dual-fellowship trained pediatric surgical oncologists in the Pennsylvania tri-state area.

Gary Mason, MD, has joined the division as a pediatric neuro-oncologist. He completed his fellowship in the Division of Neuro-Oncology at the Children’s National Medical Center in Washington DC. Dr. Mason will work closely with Ian Pollack, MD, in neurosurgery and will be leading several clinical trials in brain and CNS cancers.

Craig Byersdorfer, MD, PhD, is new to the Division of Pediatric Blood and Marrow Transplantation and Cellular Therapies. He completed his fellowship in pediatric hematology/oncology at the C.S. Mott Children’s Hospital in Ann Arbor, Michigan.

Leaders in Kidney Development Research

Pediatric Division of Nephrology faculty, Carlton Bates, MD, and Jacqueline Ho, MD, have recently been recognized for their work on kidney development research. One of the key missions of the Division of Pediatric Nephrology is to extend the knowledge of pathophysiology of renal disease through basic laboratory and clinical research.

Dr. Bates was elected to the American Society for Clinical Investigation; the medical honor society recognizes physicians who have accomplished meritorious original, creative, and independent investigations in the clinical or allied sciences of medicine. Dr. Bates studies genetic mouse models of kidney and lower urinary tract development. By suppressing or altering the activity of certain genes, he and his team are able to breed mice with structural kidney disease akin to what is seen in affected children, leading to new insights into the causes of congenital kidney and bladder diseases, which are leading causes of pediatric chronic kidney disease.

Dr. Ho was recently awarded a prestigious RO1 research grant by the NIH. She also has received numerous research awards, including the 2014 March of Dimes Basil O’Connor Starter Scholar Research Award and the 2013 International Pediatric Nephrology Association Renée Habib Young Investigator Award.

Pitt Team Discovers New Mechanism That Helps Explain Why Older Patients Develop Lung Fibrosis

PITTSBURGH, Dec. 22, 2014 – When researchers at the University of Pittsburgh School of Medicine took a closer look at certain cells from the scarred lungs of patients with idiopathic pulmonary fibrosis (IPF), they were surprised by what they saw: many misshapen, bloated mitochondria. The unexpected observation led them to conduct a study, published online today, that will be featured on the cover of the February issue of the Journal of Clinical Investigation, that could for the first time help explain why the risk of developing the deadly lung disease increases with age.

Older age is a well-known risk factor for IPF, a disease in which the lung tissue becomes progressively fibrotic, or scarred, leading to breathing difficulties and death within three to five years if a lung transplant isn’t possible, said senior investigator Ana L. Mora, M.D., assistant professor in the Division of Pulmonary, Allergy and Critical Care Medicine and a member of the Heart, Lung, Blood and Vascular Medicine Institute (VMI) at Pitt. The cause of the disease is unknown, or “idiopathic.”

“Other chronic and progressive diseases we see with aging, such as Parkinson’s disease, have been recently associated with mitochondrial abnormalities, so we wondered if that was occurring in IPF,” she said. “It was a simple question, but it hadn’t been asked before, so we examined lung cells from patients with advanced IPF and healthy people. We were so surprised to see dramatic differences in the number, shape and function of the mitochondria.”

After characterizing the oddities of the mitochondria, which provide energy for the cell, the team checked the levels of an enzyme called PTEN-induced putative kinase 1, or PINK1, that plays key roles in mitochondrial function and morphology, or shape. Experiments showed that impairment of mitochondria was associated with a reduction in PINK1 expression, and mice lacking PINK1 had dysfunctional, misshapen mitochondria in lung cells and were susceptible to developing lung fibrosis.

“We found also that low PINK1 is associated with increasing age and cellular stress,” Dr. Mora said. “This might help explain why older people are at greater risk for developing IPF, and it could mean developing drugs that can boost PINK1 levels or improve mitochondrial function will help treat IPF.”

“These findings are remarkable as they identify a similar disease pathway to that seen in other age related brain diseases,” said Mark Gladwin, M.D., professor and chief, Division of Pulmonary, Allergy and Critical Care Medicine, and VMI director, who is not on the research team. “This is the first study to find that the mitochondria themselves, the energy factories of our cells, are altered with lung fibrosis.”

In addition, the team hopes to find biomarkers to identify the disease in earlier stages as well as explore other factors that could increase susceptibility to IPF.

The research team includes Marta Bueno, Ph.D., Yen-Chun Lai, Ph.D, Judith Brands, Ph.D., Claudette St. Croix, PhD., Christelle Kamga, Ph.D., Catherine Corey, John Sembrat, Janet S. Lee, M.D., Steve R. Duncan, M.D., Mauricio Rojas, M.D., Sruti Shiva, Ph.D., and Charleen T. Chu, M.D., Ph.D., all of the University of Pittsburgh; Yair Romero, of Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City, Mexico; and Jose D. Herazo-Maya, M.D., of Yale University.

The project was funded by National Institutes of Health grants NS065789 and AG026389; the Vascular Medicine Institute at the University of Pittsburgh, the Institute for Transfusion Medicine, and the Hemophilia Center of Western Pennsylvania.

Intervention in School Health Centers is Effective in Counseling Teens About Abusive Relationships, Children’s Hospital of Pittsburgh of UPMC Study Finds

PITTSBURGH, Dec. 22, 2014 – A study by a Children’s Hospital of Pittsburgh of UPMC researcher provides the first evidence of the potential benefits of a brief, provider-delivered universal education and counseling intervention in school-based health centers to address and prevent the major public health problem of adolescent relationship abuse. The study appears online today in Pediatrics.

In collaboration with the California Adolescent Health Collaborative of the Public Health Institute, California School-Based Health Alliance and Futures Without Violence, the study was conducted during the 2012-2013 academic year at eight school-based health centers in California where students receive confidential clinical health services. Researchers surveyed 1,062 teens ages 14 to 19 for exposure to adolescent relationship abuse (including cyber dating abuse), sexual behavior, and care-seeking for sexual and reproductive health at their initial visit and again three months later.

Providers and staff in four school-based health centers received training on how to talk about healthy and unhealthy relationships; received palm-sized brochures about relationship abuse and available resources to hand out to patients; and learned how to refer youth to additional services and supports. No changes were implemented at the other four school-based health centers.

The researchers found students at the intervention sites were more likely than those at the other sites to recognize sexual coercion. Among students who reported relationship abuse at an initial visit  on a confidential survey, students at intervention schools were significantly less likely to report such abuse on the follow-up survey 3 months later.

“This study shows that a universal education and brief counseling approach in health care settings may be a useful way to address relationship abuse among adolescents,” said lead investigator Elizabeth Miller, M.D., Ph.D., chief, Division of Adolescent and Young Adult Medicine. “Clinicians talking about healthy and unhealthy relationships with all of their patients can make a difference.”

Among almost 400 youth who reported experiencing relationship abuse at an initial visit, 65 percent of students in intervention schools reported still experiencing such abuse about three months later, compared to 80 percent of students in the other schools. In addition, youth in the intervention clinics were much more likely to discuss being in an unhealthy relationship with their health care provider. “Embedding prevention messages and information about relevant resources within clinical settings for adolescents may be an effective way to reduce relationship abuse,” said Lisa James, the director of Health at Futures Without Violence and a co-investigator on the study.

“Youth seeking care in adolescent health settings appear to have more exposure to relationship abuse and associated poor health outcomes,” said Dr. Miller, also an associate professor of pediatrics, University of Pittsburgh School of Medicine. “Finding an intervention that may make a difference for these youth who are at higher risk for relationship abuse is encouraging.”

“This study effectively combined school-based clinical interventions with youth-led promotion of healthy adolescent relationships,” said co-investigator Samantha Blackburn, formerly with the California School-Based Health Alliance, and now an assistant professor of nursing at California State University Sacramento. “Not only did students receive needed services, they were also empowered to help their peers be healthy and safe.”

“Prevention of relationship abuse among adolescents requires a range of strategies from educating youth and adults about the extent of the problem; connecting youth to relevant supports and services; and engaging schools, parents, and other influential adults to talk about healthy relationships,” said co-investigator Alison Chopel from the Public Health Institute’s California Adolescent Health Collaborative.  “This intervention is a part of the prevention solution.”

Dr. Miller and her collaborators are hopeful that these findings will encourage schools and adolescent health care providers to implement this program.  For parents and educators, she adds, “This study suggests that creating spaces for young people to learn about healthy and unhealthy relationships and how to help their friends can really help to reduce adolescent relationship abuse.”

Collaborators with Dr. Miller on the study were: Heather L. McCauley, Sc.D., Kelley Jones, MPH, Rebecca Dick, MS, all with Children’s Hospital of Pittsburgh of UPMC; Sandi Goldstein, MPH, Johanna Jetton, California Adolescent Health Collaborative, Public Health Institute; Jay G. Silverman, Ph.D., Division of Global Public Health, University of California, San Diego School of Medicine; Samantha Blackburn, RN, MSN, PNP, California School-Based Health Alliance and California State University Sacramento School of Nursing; Erica Monasterio, RN, MN, FNP-BC, University of California San Francisco School of Nursing; Lisa James, Futures Without Violence; and Daniel J. Tancredi, Ph.D., University of California Davis School of Medicine.

The study was supported by Award No. 2011-MU-MU-0023 of the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice.

For more information on Dr. Miller and the Division of Adolescent and Young Adult Medicine, visit www.chp.edu/CHP/am. To learn more about how to implement this intervention, visit http://www.futureswithoutviolence.org/hanging-out-or-hooking-up-clinical-guidelines-on-responding-to-adolescent-relationship-abuse-an-integrated-approach-to-prevention-and-intervention/.

Save the Date: Breast Symposium 2015

PITTSBURGH, Dec. 19, 2014 – Breast Symposium 2015: Updates in the Management of Breast Cancer/Breast Disease will be held at the Herberman Conference Center in Pittsburgh, Pa. on Friday, April 24, 2015.

This course is designed to cover the most recent advances in breast health screening and diagnosis including methods of detection, application of new technology, and benign disease and cancer management. Upon completion of the activity, participants should be able to:

  • Discuss the latest breast cancer methods of detection, treatment, surveillance, and research
  • Describe how these advances can be applied to their practice

Who Should Attend
This course is designed for physicians, nurses and other health care professionals practicing in the areas of Primary Care, Gynecology, Radiology, and General Surgery; recommended for any practitioner caring for women.

Location
UPMC Shadyside
Herberman Conference Center
5230 Centre Avenue
Pittsburgh, PA 15232

Course Co-Directors
Marguerite A. Bonaventura, MD
Associate Professor of Surgery
University of Pittsburgh School of Medicine

Gretchen M. Ahrendt, MD
Associate Professor of Surgery
University of Pittsburgh School of Medicine

This activity has been approved for AMA PRA Category 1 Credit.TM

Online registration will be available on the Upcoming Events page at the Center for Continuing Education in the Health Sciences.

Register for the 23rd Annual Clinical Update in Geriatric Medicine

PITTSBURGH, Dec. 19, 2014 – Registration is now open for the 23rd Annual Clinical Update in Geriatric Medicine, March 26–28, 2015.

This award-winning CME conference is designed to help clinicians provide exceptional care for their older patients. Its structure, speakers, and content have been specifically chosen to provide state-of-the-art yet pragmatic approaches to the most common and confounding conditions clinicians face. The conference attracts more than 500 attendees annually.

Who Should Attend
This course is designed for family practitioners, internists, geriatricians, and other health care professionals who provide care to older adults. Previous attendees also will be interested because of the conference’s continually changing topics, speakers, and approach.

Location
Marriott City Center
112 Washington Place
Pittsburgh, PA 15219

To register online, please visit the Upcoming Events page at the Center for Continuing Education in the Health Sciences and click the ‘23rd Annual Clinical Update in Geriatric Medicine′ link.

Improving Lives of Wheelchair Users Focus of Federally Funded Pitt Project to Create Global Network

PITTSBURGH, Dec. 19, 2014 – Of the nearly 70 million people worldwide who require wheelchairs for mobility and function, most lack access to appropriate wheelchairs or services to fix them. Now, a handful of University of Pittsburgh scientists are working with the U.S. Agency for International Development (USAID) under a two-year, $2.3 million sub-award to develop the new International Society of Wheelchair Professionals, a global network to teach and professionalize device repair, build affiliations to put better equipment in the right hands, and ensure a level of standardization, certification, and oversight.

Starting in January, the International Society of Wheelchair Professionals will be launched and administered by faculty members from the Department of Rehabilitation Science and Technology in the University of Pittsburgh’s School of Health and Rehabilitation Sciences. Assistant professors Jon Pearlman, Ph.D., associate director of engineering at the Human Engineering Research Laboratories (HERL), and Rory Cooper, Ph.D., HERL founding director and Distinguished Professor of Rehabilitation Science and Technology, will serve as co-directors.

The organizers intend to create three areas critical to this international network, as outlined in the funding: train people to build capacity for wheelchair service providers around the world; develop international wheelchair standards; and initiate a broad advocacy and outreach campaign to recruit affiliates on every continent.

“For at least the last 30 years, there has been a need for an international society to help improve the quality of wheelchairs, service delivery, and repair as well,” Dr. Cooper said, “and to link consumers, designers, manufacturers, rehabilitation professionals and wheelchair users so that we can all communicate. A rising tide raises all boats, so let’s raise the level for everybody in the world.”

Added Dr. Pearlman: “USAID is part of the federal Department of State, and it tries to spread the mission of the United States internationally. In this case, it’s a grant to the University of Pittsburgh, but to build a network and an ability to professionalize services around the world to contribute to this common goal – which is to improve the lives of wheelchair users.”

Since 2002, USAID has granted more than $45 million to improve wheelchairs and wheelchair services worldwide. This sub-award – Agreement No. APC-GM-0068 — was presented by Advancing Partners & Communities, a five-year cooperative agreement funded by USAID under Agreement No. AIDOAA-A-12-00047, beginning Oct. 1, 2012.

High-Dose Flu Vaccine Superior for Frail Elderly Living in Long-Term Care Facilities

PITTSBURGH, Dec. 18, 2014 – The high-dose flu vaccine is significantly better than the regular flu shot at boosting the immune response to the flu virus in frail, older residents of long-term care facilities, according to the results of a University of Pittsburgh School of Medicine study.

It is the first evaluation of the vaccine in long-term care residents, which is the population most vulnerable to flu-related death. The study, published in the Journal of Infectious Diseases and funded by vaccine-maker Sanofi Pasteur, found that – with the exception of one strain of flu circulating in the 2012-2013 season – the high dose flu vaccine helped participants mount a better immune response to influenza than the standard flu shot.

“The elderly living in long-term care facilities have higher influenza exposure risks, lower immune defenses and a much greater likelihood of flu-related death than the general population,” said lead author David A. Nace, M.D., M.P.H., director of long-term care and flu programs in Pitt’s Division of Geriatric Medicine and chief medical officer for UPMC Senior Communities. “For these reasons, we need more effective flu vaccine options for frail, older adults.”

Each year in the U.S., there are 3,000 to 49,000 influenza-associated deaths, with over 90 percent reported among people aged 65 years and older, according to the U.S. Centers for Disease Control and Prevention. Mortality is 16-fold higher among those 85 years old compared to those 65 to 69 years. Although the influenza vaccine is the best defense against the flu, it is not 100 percent effective. Among the elderly population, clinical efficacy of the standard vaccine is reduced by 17 to 60 percent.

“In a separate randomized controlled trial of community-dwelling adults 65 years of age and older, Fluzone High-Dose vaccine induced higher immune responses and provided superior protection against laboratory-confirmed influenza illness compared with standard-dose influenza vaccine,” said David P. Greenberg, M.D., vice president of scientific and medical affairs and chief medical officer at Sanofi Pasteur U.S., the makers of Fluzone High-Dose. “We are pleased to see the results of this new randomized study demonstrating that the higher immune response to Fluzone High-Dose vaccine extends to frail, older residents of long-term care facilities.”

In December 2009, the U.S. Food and Drug Administration licensed trivalent inactivated influenza vaccine – Sanofi Pasteur’s Fluzone High-Dose – specifically designed for people 65 years and older. The high-dose contains four times the antigen of regular shots.  Antigen is the part of a vaccine that prompts the immune system to make antibodies against flu.

During the 2011-2012 and 2012-2013 flu seasons, Dr. Nace and his colleagues followed 187 people with an average age of 86.7 years living in 15 community-based, long-term care sites in western Pennsylvania, including nursing facilities, assisted or personal care homes, and independent living facilities. To ensure they were among the frail population most vulnerable to flu, only people who needed full or partial assistance in at least one daily self-care activity, such as dressing or grooming, were included.

Participants were randomly selected to receive either a high-dose or standard flu shot at the beginning of the flu season. They were then tested for their antibody response 30 and 180 days after receiving the flu shot. This helped doctors determine how much the vaccine prepared participants’ immune systems for the flu virus and also how much that protection waned by the end of the flu season.

Both the high-dose and standard flu vaccines contain inactivated versions of the three influenza strains that world health officials determine most likely to be circulating in a given flu season.

At 30 days and again at 180 days, the immune response was greater for high-dose compared to the standard vaccine for all the flu strains in both seasons, except strain A/H1N1 in the 2012-2013 season. The researchers noted that A/H1N1 was identical in both seasons, and 26 percent of participants took part in the study both seasons, something that might have caused the lower generation of antibodies to the strain in the second season.

“Historically, the protection from regular influenza vaccine among seniors has been moderate,” said senior author Richard K. Zimmerman, M.D., M.P.H., professor in Pitt’s Department of Family Medicine. “Now an option with better immunologic protection is available, as our study shows.”

The trial did not evaluate whether fewer of the high-dose recipients actually contracted the flu than those receiving the standard vaccine.

“The high-dose vaccine is not a guarantee against contracting the flu, even though it significantly decreases the likelihood,” said Dr. Nace. “That is why it is so important to take a ‘bundled approach’ to preventing flu in long-term care facilities, including vaccination of health care workers, asking people with flu-like illness not to visit residents, practicing proper cough etiquette and hand hygiene, and frequent sanitation of commonly used areas and equipment.”

Additional co-authors on this study are Chyongchiou Jeng Lin, Ph.D., Stacey Saracco, R.N., and Roberta M. Churilla, R.N., C.R.N.P., all of Pitt; and Ted M. Ross, Ph.D., of the Vaccine & Gene Therapy Institute of Florida.

In addition to the grant from Sanofi Pasteur, funding for this study was provided by the University of Pittsburgh Claude D. Pepper Older Americans Independence Center through National Institutes of Health grant P30 AG024827.

Expert in Immune Responses in Stem Cell Transplantation Joins UPCI

PITTSBURGH, Dec. 17, 2014 – Warren Shlomchik, M.D., a leading expert in investigating the immunologic mechanisms underlying graft-versus-host-disease (GVHD), a common complication for some stem cell transplant patients, has been named director of stem cell transplantation and cell therapies for the University of Pittsburgh’s Division of Hematology-Oncology and University of Pittsburgh Cancer Institute (UPCI), a partner with UPMC CancerCenter, and UPCI’s scientific director of hematopoietic malignancies.

Dr. Shlomchik’s appointment is effective March 1, 2015. He will also serve as a professor of medicine and immunology at the University of Pittsburgh School of Medicine. He comes to Pittsburgh from Yale Cancer Center at the Yale University School of Medicine, where he had been on the senior faculty for 16 years.

“Warren’s work has been invaluable in helping researchers understand more about the mechanisms of GVHD. His main priorities here in Pittsburgh will be to continue to conduct innovative, ground-breaking lab-based science and to oversee the translation of that science into investigator-initiated clinical trials, which will be a huge advance for our transplant and hematopoietic malignancies clinical research program,” said Edward Chu, M.D., chief of the Division of Hematology/Oncology and deputy director of UPCI.

Dr. Shlomchik is a leading expert in GVHD, a well-established complication that can occur after a stem cell or bone marrow transplant in which the newly transplanted donor cells attack the transplant recipient’s body. At Pitt, Dr. Shlomchik will continue his research on GVHD mechanisms as well as work to develop novel immunologic-based and cell therapy approaches to circumvent and/or overcome the development of GVHD.

“We’ve been very fortunate at UPCI this year to add several renowned researchers to our ranks, including Dr. Shlomchik,” said Nancy E. Davidson, M.D., director of UPCI and UPMC CancerCenter. “The decision of these researchers to come here shows that we are serious about the work we are doing to unravel the mysteries of cancer and take those findings directly to our patients.”

Dr. Shlomchik earned his bachelor of arts at Harvard University and his medical degree at the University of Pennsylvania. He completed his residency in internal medicine at New York Hospital/Cornell Medical Center and was a fellow at the University of Pennsylvania in hematology-oncology.

Pitt Team Publishes New Findings from Mind-Controlled Robot Arm Project

PITTSBURGH, Dec. 16, 2014 – In another demonstration that brain-computer interface technology has the potential to improve the function and quality of life of those unable to use their own arms, a woman with quadriplegia shaped the almost human hand of a robot arm with just her thoughts to pick up big and small boxes, a ball, an oddly shaped rock, and fat and skinny tubes.

The findings by researchers at the University of Pittsburgh School of Medicine, published online today in the Journal of Neural Engineering, describe, for the first time, 10-degree brain control of a prosthetic device in which the trial participant used the arm and hand to reach, grasp, and place a variety of objects.

“Our project has shown that we can interpret signals from neurons with a simple computer algorithm to generate sophisticated, fluid movements that allow the user to interact with the environment,” said senior investigator Jennifer Collinger, Ph.D., assistant professor, Department of Physical Medicine and Rehabilitation (PM&R), Pitt School of Medicine, and research scientist for the VA Pittsburgh Healthcare System.

In February 2012, small electrode grids with 96 tiny contact points each were surgically implanted in the regions of trial participant Jan Scheuermann’s brain that would normally control her right arm and hand movement.

Each electrode point picked up signals from an individual neuron, which were then relayed to a computer to identify the firing patterns associated with particular observed or imagined movements, such as raising or lowering the arm, or turning the wrist. That “mind-reading” was used to direct the movements of a prosthetic arm developed by Johns Hopkins Applied Physics Laboratory.

Within a week of the surgery, Ms. Scheuermann could reach in and out, left and right, and up and down with the arm to achieve 3D control, and before three months had passed, she also could flex the wrist back and forth, move it from side to side and rotate it clockwise and counter-clockwise, as well as grip objects, adding up to 7D control. Those findings were published in The Lancet in 2012.

“In the next part of the study, described in this new paper, Jan mastered 10D control, allowing her to move the robot hand into different positions while also controlling the arm and wrist,” said Michael Boninger, M.D., professor and chair, PM&R, and director of the UPMC Rehabilitation Institute.

To bring the total of arm and hand movements to 10, the simple pincer grip was replaced by four hand shapes: finger abduction, in which the fingers are spread out; scoop, in which the last fingers curl in; thumb opposition, in which the thumb moves outward from the palm; and a pinch of the thumb, index and middle fingers. As before, Ms. Scheuermann watched animations of and imagined the movements while the team recorded the signals her brain was sending in a process called calibration. Then, they used what they had learned to read her thoughts so she could move the hand into the various positions.

“Jan used the robot arm to grasp more easily when objects had been displayed during the preceding calibration, which was interesting,” said co-investigator Andrew Schwartz, Ph.D., professor of Neurobiology, Pitt School of Medicine. “Overall, our results indicate that highly coordinated, natural movement can be restored to people whose arms and hands are paralyzed.”

After surgery in October to remove the electrode arrays, Ms. Scheuermann concluded her participation in the study.

“This is been a fantastic, thrilling, wild ride, and I am so glad I’ve done this,” she said. “This study has enriched my life, given me new friends and coworkers, helped me contribute to research and taken my breath away. For the rest of my life, I will thank God every day for getting to be part of this team.”

The team included John E. Downey, BS, Elizabeth Tyler-Kabara, M.D., Ph.D., and Michael Boninger, M.D., all of the University of Pittsburgh School of Medicine; and lead author Brian Wodlinger, Ph.D., now of Imagistx, Inc. The project was funded by the Defense Advanced Research Projects Agency, the Department of Veterans Affairs, and the UPMC Rehabilitation Institute.

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